Perforated peptic ulcer disease in the elderly

There has been a marked decrease in elective surgery for peptic ulcer disease following introduction of medical therapies including H2-receptor antagonists (H2-RA) and proton pump inhibitors (PPI). By contrast, the incidence of emergency surgery for perforated peptic ulcer(PPU) has remained relatively unchanged, and potentially increased. Conservative treatment of PPU should be selected based on the physical condition of the patient. Open and laparoscopic repair of PPU are made with peritoneal lavage and omental patch closure of perforation. Laparoscopic repair of PPU seems better than open repair for low-risk patients. However, open repair for high-risk patients of PPU should not be delayed, and prognosis is affected primarily by concomitant medical comorbidity in the elderly.